COVID-19 in Kids and Toddlers: Symptoms Parents Need to Know
Children and toddlers usually display mild symptoms of COVID-19, but severe complications are also possible—especially for those with underlying conditions. Here's what parents need to know.
The novel coronavirus, SARS-CoV-2, (and the disease it causes, COVID-19) has the entire world on edge, but perhaps nobody is as concerned as parents. It can seem impossible to shield children from illnesses when germs are unpredictable and omnipresent. And while experts initially reported that COVID-19 mostly spares children and toddlers, recent research suggests they aren't entirely off the hook.
More than 4 million American children have been diagnosed with COVID-19, according to the American Academy of Pediatrics (AAP). This represents 14.2 percent of all coronavirus cases. "These numbers are a chilling reminder of why we need to take this virus seriously," AAP president Sally Goza, M.D., said in a news release. "While much remains unknown about COVID-19, we do know that the spread among children reflects what is happening in the broader communities."
Thankfully, COVID-19 doesn't appear to affect children as severely. In the states reporting data, between 0.1 percent and 1.9 percent of kids with COVID-19 were hospitalized, and only 0.03 percent of cases were fatal. What's more, a report from researchers in Israel, published February 2021 in PLOS Computational Biology, found that people under 20 years old are half as susceptible to COVID-19. They're also less likely to transmit the disease to others.
Early research points to daycare centers and elementary schools as not being driving factors in community transmission of the coronavirus. But even so, it's important that families continue practicing caution because children can still get the coronavirus—and spread it.
Here's what parents need to know about the COVID-19 symptoms in toddlers and children, plus tips for preventing the illness.
COVID-19 Symptoms in Kids and Toddlers
It's important to note that COVID-19 doesn't look the same for everyone. Many children experience no side effects whatsoever, while others get mild symptoms that resemble the common cold. Very few have severe cases that lead to respiratory distress or death (although this is rare). Tragically, Black and Hispanic populations are most at risk.
COVID-19 symptoms generally appear within two to 14 days of exposure. Fever and cough are most common, according to the Centers for Disease Control and Prevention (CDC), but kids and toddlers might experience any of the following side effects.
- Runny nose or congestion
- Sore throat
- Gastrointestinal issues (like nausea, vomiting, or stomachache)
- New loss of taste or smell
- Shortness of breath
- Body aches
- Poor appetite
"Symptoms of COVID-19 are similar in adults and children and can look like symptoms of other common illnesses such as colds, strep throat, or allergies," notes the CDC. The organization also adds that a recent systematic review estimated 16 percent of children had asymptomatic COVID-19—"but evidence suggests that as many as half of pediatric infections may be asymptomatic."
So how long does COVID-19 last in kids? It varies for every person. Most symptomatic children will recover within two weeks, but if they have complications, it could take a little longer to get better.
Can Kids Have COVID-19 Complications?
While most children get mild cases of COVID-19, severe complications happen on rare occasions. The risk of serious illness seems to increase if the child has an underlying medical condition. According to the CDC, these conditions include congenital heart disease, obesity, asthma or chronic lung disease, diabetes, or sickle cell disease.
A study published on May 11, 2020 in JAMA Pediatrics focused on the "early experience of COVID-19 in pediatric intensive care units (PICUs)" by collecting research from 46 PICUs in North America. It found that 48 American children were admitted to 14 PICUs between March 14 and April 3, 2020. A majority (83 percent) had underlying medical conditions, 38 percent needed ventilators, and 4.2 percent died.
Rarely, the coronavirus can lead to a condition dubbed multisystem inflammatory syndrome in children (MIS-C). Several children have died from the mysterious illness, which resembles Kawasaki disease. Symptoms include fever, rash, abdominal pain, vomiting, diarrhea, bloodshot eyes, fatigue, and neck pain, according to the CDC. And while more information is needed, experts think it may be an immune system overreaction to COVID-19 exposure.
Teenagers aren't off the hook either. In fact, experts are currently seeing more COVID-19 cases in older teens. There are a few reasons behind this trend: Teens aren't practicing social distancing as strictly, they might not believe the coronavirus will affect them, and they're more likely to vape. Vaping and cigarette smoking has been associated with an increased risk of the coronavirus, since these actions compromise the respiratory system, according to the Cleveland Clinic.
Why is COVID-19 Usually Mild in Children and Toddlers?
Since COVID-19 is a novel disease, experts still don't know many things about it—including why children usually have lower transmission rates and milder symptoms. "We don't definitively know the reason," says K.C. Rondello, M.D., MPH, CEM, clinical associate professor at the College of Nursing and Public Health at Adelphi University.
That said, here are a few theories within the medical community:
Kids have a different immune response. One theory is that children have better immune responses than adults, which helps them fight off the coronavirus. "Children's immune systems are not fully functional until later in their development. As a result, they have a considerably stronger and more robust immune response to pathogens than adults," explains Dr. Rondello. Many experts tentatively support the hypothesis, but there's also a hitch: The coronavirus seems to spare most infants even though their immune systems aren't fully formed yet.
Kids have fewer preexisting conditions. "The death rate for COVID-19 is higher among individuals with certain pre-existing conditions, such as cardiovascular disease, diabetes, and cancer. This may help explain why many children seem to be at lower risk, since they are less likely to have these types of preexisting conditions," says Aimee Ferraro, Ph.D., faculty member for Walden University's Master of Public Health (MPH) program.
Experts might not be identifying all coronavirus cases: Robert Frenck, M.D., medical director of the Division of Infectious Diseases at Cincinnati Children's Hospital, says that a reporting bias might be to blame. It's possible that children with mild or asymptomatic cases aren't being tested for COVID-19—which means the coronavirus may be affecting more children than reported.
Kids could have "immunological cross-protection": According to Dr. Rondello, a number of different viruses could give you the common cold—including milder forms of coronavirus. "Children get colds a lot, so they're already being exposed to more benign, less intense coronaviruses. They could have potentially built immunity to them," he says. Dr. Rondello calls this "immunological cross-protection."
My Child Has COVID-19 Symptoms: Now What?
Does your child have fever, cough, sore throat, runny nose, nausea, or other symptoms of COVID-19? Keep them away from other family members while you call their doctor. They might recommend getting a COVID test, depending on your child's symptoms, risk factors, and potential exposure.
Your child (and other unvaccinated members of the household) will need to quarantine until you receive COVID test results—and they'll need to isolate at home if the test comes back positive. Give the sick person their own bedroom and bathroom, if possible, and take other preventive measures to contain the illness. Learn more about caring for someone with the coronavirus here.
Seek medical help immediately if your child has difficulty breathing, chest pain, confusion, inability to stay awake, changing skin color (especially if the skin looks pale, blue, or gray), or other worrisome symptoms.
How to Prevent COVID-19 in Children
Like the cold and flu, the coronavirus is a respiratory illness that spreads through contaminated droplets. These droplets enter the body through the eyes, nose, and mouth, says Miryam Wahrman, PhD, biology professor and director of the microbiology research lab at William Paterson University in Wayne, New Jersey, and author of The Hand Book: Surviving in a Germ-Filled World. The CDC says that airborne transmission is also possible.
Kids under 12 years old aren't able to get vaccinated yet (although this might change soon). They should follow all CDC guidelines to prevent infection: wearing a mask in public, practicing social distancing, and washing hands often. Alcohol-based hand sanitizer can also work in a pinch.